Taxes and Being Mortal

The way that I think (or don't think) about becoming old is the same way that I think or don't think about my taxes. In other words, very big life changing factors like assisted living facilities and being able are things that I've subconsciously reserved for the later years of my life, bridges that I intend to cross at some point, but won't waste my energy until then. 

"That's wrong and irresponsible". Atul Gawande didn't say that to me directly, but based on his newest book, I feel like that is what he would say to me in a one on one conversation. Growing old and becoming mortal is perhaps one of the most important elements of life we have yet to understand fully, and Atul Gawande makes that point through a mix of factual evidence and anecdotes in his latest book Being Mortal

Below is a list of things that I learned from Being Mortal that I did not know beforehand:

1) The Hill-Burton Act of 1946, which provided federal grants and loans for hospital construction, is both the most high impact and the most overlooked piece of healthcare legislation to pass through Congress. This act is responsible for financing over nine thousand new medical facilities, in turn creating the the new field of medicine and the modern hospital today. 

2) Only in the 1980s did assisted living facilities come into fruition when Keren Brown Wilson attempted to build an alternative to nursing homes so that "she could create a place where people could live with freedom and autonomy no matter how physically limited they became." Just because you are old and frail, doesn't mean you have to submit to life in an asylum, which is how some perceive nursing homes to be, with their rigorous routines and rules. 

3) Health professionals have agreed upon a formal classification system for a set of capabilities that collectively define whether a person is fully functioning. These attributes are called the "Activities of Daily Living" and they are:

  • using the toilet
  • eating
  • dressing
  • bathing
  • grooming
  • getting out of bed
  • getting out of a chair
  • walking

Inability to perform any of these eight activities deems a person incapable of basic physical independence and in need of a nursing home or some kind of assisted help. 

4) "As medical progress has extended our lives, the result has been what's called the 'rectangularization' of survival. Throughout most of human history, a society's population formed a sort of pyramid: young children represented the largest portion - the base - and each successively older cohort represented a smaller and smaller group. In 1950, children under the age of five were 11 percent of the US population, adults aged forty-five to forty-nine were 6 percent, and those over eighty were 1 percent. Today, we have as many fifty-year-olds as five-year-olds. In thirty years, there will be as many people over eighty as there are under five. 

5) The definition of "socioemotional selectivity theory": "how we seek to spend our time may depend on how much time we perceive ourselves to have. When you are young and healthy, you believe you will live forever. You do not worry about losing any of your capabilities. People tell you "the world is your oyster," "the sky is the limit," and so on. And you are willing to delay gratification - to invest years, for example, in gaining skills and resources for a brighter future. You seek to plug into bigger streams of knowledge and information. You widen your networks of friends and connections, instead of hanging out with your mother. When horizons are measured in decades, which might as well be infinity to human beings, you most desire all that stuff at the top of Maslow's pyramid - achievement, creativity, and other attributes of 'self-actualization.' But as your horizons contract - when you see the future ahead of you as finite and uncertain - your focus shifts to the here and now, to everyday pleasures and the people closest to you."

6) There is irony (and also poetic flair) in this conversation: The field of medicine focuses primarily on the science of preserving life, but rarely do we speak about the art of being mortal. Gawande's book was the first time I'd ever looked at that art seriously.